Clients search for understanding as language barriers complicate mental health treatment

Second of three parts.

Ana Paula Guerrero's child is having a hard time with her sports coach, and it's making her miserable and the whole family unhappy.

Guerrero decides to seek the help of a therapist, and at first she's indifferent to whether it's someone who speaks her native Spanish or her adopted language, English.

But during her second session, it hits her - it's just so much easier, and so much better for therapy, when she can express herself without translating her emotions.

"When you're talking about feelings, talking in your native language makes a difference for sure," the Aurora resident says. "When I am talking about certain feelings in Spanish, it's (about) vocabulary and being able to gather the words to express yourself. It's not the feeling itself, but the ability to communicate what you are experiencing."

There are 2.5 million people - among a population of nearly 8.4 million in Cook, DuPage, Kane, Lake, McHenry and Will counties - who speak a language other than English at home.

Meanwhile, one in two people will have a diagnosable mental health condition during their lifetimes, and one in five adults in any given year, according to Mental Health America.

That means as many as 500,000 foreign-language speakers could need mental health help every year, and there's a dire need for more bilingual counselors, psychologists and psychiatrists, suburban providers say.

"We prefer people be treated in the language of their choice, the one they feel most comfortable with," said Jerry Murphy, executive director of the INC Board, a community mental health funding alliance in southern Kane County. "There is a shortage of qualified bilingual, bicultural mental health personnel. Agencies are stealing from each other all the time."

Missing vocabulary

Such is the shortage of Polish-speaking therapists that clients travel from as far as Woodstock and the South suburbs to meet with Joanna Huk, a Polish-born licensed clinical psychologist with Alexian Brothers Behavioral Health Hospital in Hoffman Estates.

Providing therapy in another language requires fluency, of course, but also depth of lexicon and terminology to properly diagnose and help clients, Huk said.

"It can pose issues between the therapist and the client when you're trying to access that vocabulary and you don't have it," she said.

The more severe the illness, the more crucial language becomes for both patients and providers, said Rocio Santiago, a bilingual psychotherapist at Open Door Health Center of Illinois in Elgin.

"For example, schizophrenia is very difficult (to treat) when there are language barriers," she said. "You have to describe what you see or hear. And if you can't do that, it's a problem."

There are very few therapists in the suburbs who speak Arabic, said Amr Kireem, a licensed professional counselor in Rolling Meadows whose clients are from Morocco, Egypt, Saudi Arabia, Lebanon and Iraq.

It's helpful to have a therapist who can communicate with relatives, especially when the client's issues are connected to family conflict, often the case for second- and third-generation immigrants pulled between their culture of origin and their American culture, Kireem said.

"It's very difficult to talk with the family about these things," he said. "It takes a lot more time to get through. And, sometimes, it's impossible."

Mario Guzman, a Mexican native and bilingual psychologist in Naperville, also works with generations of immigrants who are dealing with depression, anxiety, post-traumatic stress and personality disorders as they confront the challenges of adjusting to a new culture and language.

He sees between 25 and 30 clients a week, in both Spanish and English, as he works for Chicago-based Agave Studio for Psychotherapy and Spiritual Direction. He has a short waiting list, especially for Spanish speakers, and every time he takes a new client off it, he hears how difficult it is to find a psychologist who speaks the language.

Multilingual needs

There isn't one unified, simple source that lists bilingual mental health providers in the suburbs, said Cristina Cox, a professor in the department of clinical psychology at Adler University in Chicago and diversity liaison with the Illinois Psychological Association.

There are 9,550 licensed counselors in Cook, DuPage, Kane, Lake, McHenry and Will counties, as well as 3,786 licensed clinical psychologists. But the state department tracking them doesn't record how many offer services in a language other than English.

Psychology Today's website offers a search feature to find therapists based on geography and factors including language, but it doesn't compile all bilingual providers into one organized list.

"There isn't really one good source," said Cox, who is bilingual in Spanish. "That's exactly the problem."

Every agency with which Adler University partners wishes for a deeper pipeline of bilingual students, Cox said.

That's why graduates such as Amy Zepeda, 24, of Aurora, a behavioral health clinician at Family Counseling Services in Aurora, are in such high demand.

Zepeda received a $13,000 scholarship from the INC Board as a Spanish-speaking bilingual student seeking a master's degree in social work from Aurora University. The board also provides one bachelor's-level scholarship each year for a Latino or African-American social work student, giving preference to students at Aurora University or those from the Fox Valley.

Zepeda helps children who have been hospitalized or have experienced suicidal thoughts, are having conflicts with peers, are injuring themselves, or have depression, anxiety or a mood disorder.

"Parents are hesitant about therapy services because there can be a stigma about mental health in the Latino community," she said. "I'm able to really break it down and explain that what they're trying to do is find more help for their child so the child can succeed."

She also tells parents - in Spanish, in many cases - that these symptoms don't mean their child is crazy, just that he or she needs "extra empowerment."

Sometimes, the best thing is to simplify concepts so clients don't feel daunted, said Ale Bugaro, a senior therapist with the Lake County Health Department and Community Center. Some of her Spanish-speaking clients have limited education, and it's important to be sensitive about that.

"Instead of saying, 'depressed,' I say 'sad,' so they understand," she said. "You have to bring it down to their language, you have to know who you are talking to so you can help them."

Feelings to words

Some therapists use interpreters, either via phone or in person, to communicate with clients. The interpreters help comply with laws that require language access for patients of all health providers that accept federal funds, such as Medicare or Medicaid.

Arlington Heights psychiatrist Dr. Deepak Kapoor of AMITA Health Alexian Brothers Center for Mental Health speaks Hindi, Urdu and Punjabi in addition to English. Others at the practice speak Spanish, Portuguese, Italian and another Indian language, Mayalam. But even at such a multilingual facility, Kapoor said he uses an interpreter for between 10 percent and 15 percent of his 500 to 600 clients.

Translating clients' words is easy, but conveying their pathos and feeling is much more difficult, said Marcos Bostho, a therapy interpreter at Open Door Health Center of Illinois in Elgin, where he works as outreach and prevention coordinator. When he feels he isn't able to emote sufficiently, Bostho says he has a chat with the therapist afterward to fill in the gaps.

"When you have a conversation with someone, that person is opening his or her heart with you directly," he said. "Sometimes, that same feeling is hard (for me) to direct to the provider. It's something that hits you as a human."

There's a huge need for support within the Latino community, but few Spanish-speakers are involved with the National Alliance for Mental Illness, said Laurie Huske, board president for NAMI Kane County North.

The group offers a free, 10-session educational program for adults with mental illness who want to understand their condition and the journey toward recovery. As hard as she's tried, it's been nearly impossible to find someone to teach it in Spanish, Huske said.

"We've reached out and reached out, and I've gone to other agencies asking for help," she said. "Sometimes people express an interest, but they don't follow through."

All about expression

Even when a language barrier presents challenges, it doesn't mean therapy is doomed, says Mudita Rastogi, a professor of clinical psychology at the Illinois School of Professional Psychology in Schaumburg and a licensed marriage and family therapist at Aspire Consulting and Therapy in Arlington Heights.

She speaks Hindi and Urdu and has good comprehension of Gujarati, but she often takes on clients who speak Farsi, Polish or Spanish as well.

"I'll say, 'Go ahead and say it as you would to someone who speaks your language,'" Rastogi said. "Just explain it in your native language, and we'll worry about the translation later."

Even if Rastogi doesn't understand, she helps her clients process the way they've described their feelings in their native words. The process builds trust, which she says is critical to keeping bilingual clients in treatment.

"I'm not so worried about what did they actually say," Rastogi says. "I'm more concerned about them being able to express themselves."

• Coming Tuesday: Even comfortably middle-class suburban residents find it challenging to pay for mental health care, making the cost of treatment discouraging for many who need help.

Solving mental health language barriers

Why mental health matters

  Therapist Ale Bugaro listens to a client at the Lake County Health Department Community Health Center in Libertyville. Bugaro says she speaks in simple terms when she meets with clients, whether in Spanish or English, to ensure they aren't daunted by tricky terminology. Gilbert R. Boucher II/
  Amy Zepeda is a behavioral health clinician at Family Counseling Services in Aurora who received a scholarship for being a Spanish-bilingual student seeking a master's degree in social work from Aurora University. She says her understanding of Spanish and the Latino culture helps her dispel the stigmas clients and their families feel about mental health treatment. Rick West/
  Mario Guzman is bilingual psychologist in Naperville, where the Mexican native says he always hears relief from clients he accepts off his waiting list for Spanish-speaking services. Bev Horne/

Language resources for mental health

Health care providers receiving federal funds are required to provide language access for all patients, including intrepreters and translators for mental health. Here are some other resources to find mental health help in several languages.

Health departments

Cook: (312) 864-8020 or <a href=""></a>

DuPage: (630) 682-7400 or <a href=""> mental-health</a>

Lake: (847) 377-8180 or <a href=""> Behavioral-Health-Services</a>

Kane: (630) 208-3140 or <a href=""> mental_health.htm</a>

McHenry: (815) 455-2828 or <a href=""> government/departments-j-z/mental-health-board/</a>

Will: (815) 727-8521 or <a href=""> Behavioral-Health</a>

National Alliance on Mental Illness

Barrington Area: (847) 496-1415 or <a href=""></a>

DuPage County: (630) 752-0066 or <a href=""></a>

Kane County North: (847) 695-7957 or <a href=""></a>

Kane-south, DeKalb and Kendall counties: (630) 896-6264 or <a href=""></a>

Lake County: (847) 249-1515 English, (224) 818-6264 Spanish or <a href=""></a>

McHenry County: (815) 308-0851 or <a href=""></a>

Northern Cook County: (847) 716-2252 or <a href=""></a>

Northwest Suburban: (847) 899-0195 or <URL destination="">naminorthwest</URL>

Schaumburg Area: (630) 363-1846 or <a href=""></a>

Will/Grundy counties: (815) 731-9103 or <a href=""></a>

Asian Health Coalition

Offers connections to mental health providers from various Asian backgrounds. Chicago office, 180 S. Washington St., #1000: (312) 372-7070 or <a href=""></a>

Ecker Center for Mental Health

Services in Spanish. 1845 Grandstand Place, Elgin: (847) 695-0484 or <a href=""></a>

Hamdard Healthcare

Services in Bosnian, Croatian, Hindi, Serbian, Urdu. Addison health center, 228 E. Lake St. #300: (630) 835-1430 or <a href=""></a>

IL Coalition for Immigrant and Refugee Rights

Information about mental health services in Spanish and other languages. (312) 332-7360 or <a href=""></a>

Maryville Academy Family Behavioral Health Clinic

Information in Spanish, Polish.Des Plaines clinic, 1455 Golf Road, Suite 210: (847) 390-3004 or <a href=""></a>

Open Door Health Center of Illinois

Services in Spanish. 1665 Larkin Ave., Elgin: (847) 695-1093 or <a href=""></a>

Psychology Today

Search for therapists, psychiatrists, support groups, treatment facilities by location and language. <a href=""></a>

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